Nurse Case Mgr I (US)
Core
Manage care plans for members with complex and chronic care needs by assessing needs, coordinating resources, and monitoring health outcomes across the care continuum.
Role type
Licensed RN Case Manager
Builds
Optimized member health care plans and care continuum management
Domain
Healthcare / Insurance
Required skills
RN licensure, care plan development, resource coordination, benefit authorization, provider negotiation, claims resolution
Preferred skills
Case Manager certification, BS in health or human services
Responsibilities
Conduct assessments to identify individual needs and develop specific care management plans; Implement care plans by facilitating authorizations and referrals; Coordinate internal and external resources to meet identified needs; Monitor and evaluate effectiveness of care management plans; Interface with Medical Directors and Physician Advisors; Negotiate rates of reimbursement; Assist in problem solving with providers and claims issues